Meaningful goals & objectives should drive every presentation

The idea of incorporating goals and objectives into presentations has percolated fairly deeply into medical teaching tradition. Unfortunately, these goals and objectives are often superficial and meaningless, especially when they are not tied meaningfully to the presentation's content. Frequently in presentations, it's hard to tell the difference between stated goals and objectives, even though they should be quite distinct and serve different purposes.

Before I provide some examples, let's review for a moment what the purpose of educational objectives are:

• Educational objectives describe the skills learners should possess after you finish your presentation.
• Educational objectives also serve as the foundation of evaluating your presentation; you measure the success of your presentation based on how well your learners met your objectives.

High quality objectives are, therefore, precise and measurable. Objectives are not the same as goals; goals can be as pie-in-the-sky and impossible to measure as you like! Goals provide the emotional power to your presentation; typically, you won't share them with your audience, but they are the fuel for your presentation.

Here's an example. I gave an hour-long presentation on asthma to our residents recently, and the objectives were:

1. Classify asthma severity using the EPR-3 guidelines.
2. Calculate a peak flow %.
3. Design appropriate treatment plans for your patients with asthma.

My unspoken goal was:

• Train residents to recognize under-treated or undiagnosed asthma so affected patients don't suffer unnecessarily.

It would be very difficult to quantitatively measure the success of my goal; I would need to know, somehow, which cases of undiagnosed asthma they missed along with the ones they caught. That's completely unrealistic, which is okay - the goal provided me with the passion and energy I needed to get my learners excited and interested in this topic. Your learners can tell when you are not emotionally invested in the material you're teaching, and they won't learn as well without your enthusiasm.

On the other hand, measuring my objectives was easy, and I was able to do so by the end of my presentation. I observed all of our residents who were present work through clinical scenarios where they had to (1) classify asthma severity, (2) calculate peak flow %s, and (3) design treatment plans. Having these clinical scenarios (and the space to write out their answers) incorporated into the handout I provided them was essential to both this measurement and the residents' concrete application of what I taught them.

In summary:

Goal = mega-aspirational, pie-in-the-sky ideal result of your presentation that fuels your passion for the topic.

Objective = precise, measurable criteria that both point learners to your most important teaching points and allow you to measure the success of your presentation.

Bloom's taxonomy provides a great starting point for choosing high-quality verbs for your objectives; "understand" and "review" are fine for goals but have no place in a well-written objective (being neither precise nor measurable). Use Bloom's to connect your objective to the appropriate step of the taxonomy (do you want them to remember? comprehend? apply?) as discussed in my earlier post about interactive presentations.

Now, get out there and write some kick ass goals and objectives!

Designing learner-centered presentations

As I discussed recently, too many educational sessions in medicine are ineffective. Most of the educational sessions I've seen aren't true presentations, at least not according to my definition:

A "presentation" is a deliberately planned educational activity that incorporates ample opportunity for learners to immediately apply and reinforce new knowledge.

In contrast, a "talk" is nothing more than a speaker or teacher droning on, typically zooming through far more material than any learner could hope to remember afterwards.

Even if delivered by an engaging speaker, talks don't result in any meaningful information gains for learners. Think back to the last talk you attended; even if it was just last week, I bet you can't recall more than 1-2 facts from it (and if you've got 1-2, you're doing better than most).* Adult learners simply aren't wired to memorize reams of facts without context and/or without the opportunity to apply those facts to concrete examples. Even the most motivated of adult learners will struggle to take away something meaningful from observing a talk.

The solution is to incorporate learning activities into educational presentations. Here's one relatively fool-proof presentation formula (warning: this formula will not work if your presentation objectives are weak):

• Introductions; review presentation objectives
• Teach content re: objective 1
• Learning activity re: objective 1
• Teach content re: objective 2
• Learning activity re: objective 2
• Teach content re: objective 3
• Learning activity re: objective 3
• Wrap-up; questions; evaluations

The learning activity should directly correlate to its learning objective. So, if one objective is to "List the four types of allergic rhinitis," the learning activity might be to identify which of the four types applies to various patient scenarios, thereby reinforcing what the four types are along with their definitions. If a second objective is to "Describe the classes of medications available to treat allergic rhinitis," then the learning activity might be to match various allergic rhinitis medications with their mechanism of action. 

Each learning activity should fit with the objective's place on the Bloom's taxonomy pyramid. Here are some suggested learning activities for each step of the taxonomy, from top to bottom:

Creating: create a new process or workflow, brainstorm solutions, write/paint/reflect on a recent patient/peer encounter

Evaluating: rate the quality of a group of clinical trials, assess the pros/cons of an office/hospital workflow

Analyzing: categorize disease types by severity, compare and contrast different treatment approaches

Applying: calculate sensitivity/PPV/NNT/etc, diagram the pathophysiology of a disease/condition

Understanding: interpret diagnostic test findings, explain a medication's mechanism of action

Remembering: recall the typical patient history of a disease/condition, list common physical exam findings for a disease/condition

As you can see, it's often appropriate for your objective to precisely reflect the corresponding learning activity.

Most of the time, when we are teaching medical content, we're working within the bottom 3 tiers of Bloom's. But I challenge you to consider how your presentations might incorporate some of the top 3 tiers; especially in curricula on practice management, quality improvement, medical humanities, and evidence-based medicine, where infinite opportunity exists for our learners to analyze, evaluate, and even create.

* The exceptions to this fact are those rare individuals with a photographic or eidetic memory.